Provider Demographics
NPI:1811986920
Name:HERNANDEZ, THOMAS MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2055 MILITARY TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7801
Mailing Address - Country:US
Mailing Address - Phone:561-741-1705
Mailing Address - Fax:561-741-7947
Practice Address - Street 1:2055 MILITARY TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-741-1705
Practice Address - Fax:561-741-7947
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD425852207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5613097113OtherCELL